Non Vital Tooth Bleaching: A Case Report

CASE REPORT

A 30-year-old female patient came to the department of censervative dentistry and endodontics with a chief complained of discoloured tooth in the upper front tooth region since 4 years. The right and left central incisors of the maxilla was structurally sound and undamaged upon inspection. Negative results from the vitality test and mild surface abrasion. A full root canal obturation without periapical disease was visible on an intraoral periapical radiograph.The patient received an explanation of the bleaching process and gave her agreement to get both inside and outside in-office power bleaching therapy to treat stained teeth.¹⁰

The tooth that was to be bleached was isolated using a rubber dam, cleaned with pumice, and the shade was selected. Up to 2 mm of the obturated material was taken out of the tooth's gingival edge. Over the gutta-percha, 1 mm of glass ionomer cement (type 1, GC Corporation, Singapore) was applied. Dentinal tubules were opened after the pulp chamber was etched with 37% phosphoric acid for 30 to 60 seconds, cleaned, and dried. After that, a thick paste containing 38% hydrogen peroxide (Pola Office Ultradent, USA), a bleaching agent, was promptly applied to the tooth's exterior labial surface and pulp chamber.

The tooth was cleaned and the remaining bleach inside was removed with water and a powerful suction machine after 10 to 15 minutes. Immediate tooth's shade was assessed. Utilising tooth-colored composite resin, the access and the pulp chamber that was only partially empty were repaired.

DISCUSSION

Treatment methods for discoloured anterior teeth that have undergone endodontic treatment vary.⁶ The bleach can be used in-office and has numerous benefits over traditional methods. It is particularly effective in treating tooth discolouration and the crown of the tooth. This article talks about the bleach that was used in-office on this patient. When a tooth is reasonably intact and has become discoloured as a result of devitalization, bleaching is preferred over crown implantation.¹¹ The majority of the residual tooth structure, not the dowel, may provide strength and resistance to fracture for the endodontically treated tooth, according to in vitro research.¹²

A laminate veneer might be a less harmful option than a crown. It might conceal the discoloration but it might also crack, debond, or marginal leak. But it necessitates teeth preparation and is permanent.¹³

Given the aforementioned factors, in-office bleaching was planned for this patient, and the patient was satisfied with the results. The main benefits of this strategy are that it is more conservative, more effective at removing stains, and considerably enhances the colour of teeth. Therefore, the dentist should use in-office bleaching the most frequently since it gives them total control over the procedure during the entire procedure.¹⁴

CONCLUSION

Pulp involvement may or may not occur following anterior tooth trauma, fracture, or fractures. When choosing a form of therapy, a type of restorative material, and a type of tooth preparation, the quantity of tooth structure lost, the position of the fracture, and the severity of discolorations are taken into account. When an anterior tooth is stained and non-vital but structurally sound, endodontic treatment with a small cavity opening and bleaching on both the interior and outside is preferred. This method requires less tooth structure to be removed from the teeth than total ceramic, ceramic fused to metal, or veneers, which are also more expensive and cause irreparable damage. This type of bleaching offers patients good aesthetics and financial advantages. The intrinsic stain's type can have an impact.

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